Knee CPG and SR Flashcards Preview

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Flashcards in Knee CPG and SR Deck (14):
1

Risk factors

chondral lesion / mensical injury

after ACL injury

  • age
  • longer time from injury

2

Ottawa knee rules

  • >55yo
  • isolated TTP patella (no other)
  • TTP head of fibula
  • inabilty to flex to 90o
  • inability to bear weight 4 steps regardless of limping

3

Mensical tear diagnosis (hx & obj)

  • Hx
    • twisting injury
    • tearing sensation at time of injury
    • delayed effusion
    • "catching" or "locking"
  • Obj
    • pain with forced hyperextension
    • pain with max flexion
    • pain/audible click with McMurray
    • joint line tenderness
    • discomfort/locking/catching over MJL/LJL during THessaly at 5o/20o flexion

4

Knee outcome measures

  • SF36
  • KOS-ADLS
  • KOOS
  • IKDC
    • MDC 12.8 (8.8 for meniscus)
    • MCID 20.5
  • Cincinnati
  •  

5

Meniscal CPR

 

 

  • hx mechanical catching/locking
  • joint line tenderness
  • pain w/ forced knee hyperextension
  • pain w/ maximum passive knee flexion
  • pain/audible click with McMurray

5/5 --> Sn .11 Sp .99 +LR 11.2, -LR .90

4/5 --> Sn .16 Sp .96 +LR 4.3 -LR .87

for medial: JLT (rules in / out)

for lateral: Thessaly at 5o (rules out) + JLT (rules in)

 

6

Coper criteria

 

ALL criteria

  • # of giving-way episodes <= 1
  • single limb 6-m timed hop >= 80%
  • KOS-ADLS >=80%
  • GRS >=60%

7

knee ligament sprain interventions

  • STRONG
    • therex (CKC & OKC)
  • Moderate
    • post-op bracing MEH
    • immediate (vs. delayed) immobilization
    • supervised rehab
    • neuromuscular e-stim
  • weak
    • early WB
    • functional knee bracing (ACL deficiency)
    • continuous passive motion
    • cryotherapy
    •  

8

factors female ACL injury

  1. ligament dominance
  2. quadriceps dominance
  3. leg dominance
  4. trunk core dominance

9

mensical & chondral lesion interventions

  • Moderate
    • Therex
    • neuromuscular stimulation
  • weak
    • progressive knee motion
    • progressive return to activity (meniscus)
  • expert opinion
    • progressive return to actity (chondral)
  • conflicting
    • supervised rehab
    • progressive weight bearing

10

articular cartilage lesion diagnosis

  • Hx
    • acute trauma with hemarthrosis (0-2 hr)
    • insidious onset aggravated by repetitive impact
    • intermittent pain & swelling
    • hx of "locking/catching"
  • OBJ
    • joint line tenderness

11

Knee OA diagnosis

  • Category 1
    • knee pain & crepitus w/ active motion
    • morning stiffness < 30 min
    • age >38
  • Category 2
    • knee pain & crepitus with active motion
    • morning stiffness > 30 min
    • bony enlargement
  • Category 3
    • knee pain
    • bony enlargement

Sn 89%

Sp 88%

12

Knee OA interventions

  • STRONG
    • low-intensity resistance program
  • Moderate
    • high-intesnsity resistance program
    • aquatic exercise not better/worse than other
    • adding MT to exercise = moderate effect on pain

13

PFPS diagnosis

  • Squatting with pain -LR 0.2
  • Patella tilt test +LR 5.4

14

PFPS rehabilitation

(2016 consensus statement)

  • Exercise
    • combining hip & knee
  • Foot orthoses
  • Electrophysical agents & Mobes (PF, knee, lumbar) may not improve outcomes